Chemotherapy Can Boost Survival

More effective risk-adjusted chemotherapy and sophisticated patient monitoring helped push cure rates to nearly 88 percent for older adolescents enrolled in a St. Jude Children's Research Hospital acute lymphoblastic leukemia (ALL) treatment protocol and closed the survival gap between older and younger patients battling the most common childhood cancer.

A report noted that overall survival jumped 30 percent in the most recent treatment era for ALL patients who were age 15 through 18 when their cancer was found.

The study compared long-term survival of patients treated between 2000 and 2007 in a protocol designed by St. Jude investigators with those enrolled in earlier St. Jude protocols. About 59 percent of older patients treated between 1991 and 1999 were cured, compared with more than 88 percent of children ages 1 through 14 treated during the same period.

But overall survival for older patients rose to almost 88 percent between 2000 and 2007, when long-term survival of younger patients soared to about 94 percent. Nationally, about 61 percent of ALL patients age 15 to 19 treated between 2000 and 2004 were still alive five years later.

Not only did more patients in the recent treatment era survive they are also less likely to suffer serious late treatment effects, including second cancers and infertility. That is because the regimen, known as Total XV, eliminated or dramatically reduced reliance on drugs associated with those side effects.

The protocol also replaced radiation of the brain with chemotherapy as a strategy for preventing relapse in the central nervous system and for reducing the risk of later neuro-cognitive problems. None of the adolescents suffered central nervous system relapses. "Not only have we increased the cure rate, but we have also improved the long-term quality of life for our patients," Pui said.

The findings come amid growing evidence that adolescents and young adults with ALL do better when treated on pediatric rather than adult protocols. "There are a lot of data to show that young adults with ALL treated on pediatric protocols have fewer relapses than similar patients treated on adult leukemia protocols," Mary Relling, chair of St. Jude Pharmaceutical Sciences Department and co-author of the research said.

She noted that these results suggest ALL patients in their 20s and 30s might benefit from adding high-dose methotrexate and asparaginase to treatment. Both drugs block proliferation of cancer cells. They are not widely used in adult cancer treatment, in part because increased age is associated with more complications.

Pui said Total XV also demonstrated the vast majority of older adolescents can be cured without undergoing a bone marrow transplant. "This lesson should be extended to young adults," he added.